Top 6 Facial Filler Myths

"An extreme close up shows a doctor placing a wrinkle remover into a woman's forehead"
Zapping “The 11’s”
  • Myth:   All  facial fillers and wrinkle removers are good, but various fillers do different things; what’s appropriate for one condition – like Botox or Dysport for crow’s feet – may not be the right for, say, lip fillers. Before your appointment, read up on which facial fillers are appropriate for which areas.
  •   Myth: Any cosmetic plastic surgeon can put fillers under the eyes. Facial fillers can certainly correct depressions under the eyes, but you need a plastic surgeon who has done the procedure for years. Why? Fillers in the wrong place around the eyes can be risky and cause very serious complications.
  •      Myth: Getting facial fillers is painful. Imagine lip injections! Cosmetic surgeons know all about pain control and use it liberally. Topical (spread on your skin) numbing agents are plentiful and make the syringe work go smoothly with no discomfort. In some sensitive locations like the lips, your doctor may add on a dental block too. Another reason not to get apprehensive: most hyaluronic injectables contain lidocaine, a powerful pain killer.

(For a weathered, aged, wrinkled face consider chemical wrinkle remover.)

  • Myth: You’ll become addicted. No addictive agent is used, so your face can’t cause addiction. What actually causes that rumor: you are very likely to love the look of your face so you’ll go back continually. Perhaps. But hyaluronic acid facial fillers are made to last between six months and two years, depending on what’s used and where. Hyaluronic acid is slowly absorbed by the body, but may leave behind some new collagen growth. (Collagen is the main structural protein found in connective tissue; so, the more, the better.)
  • Myth: Filler injections are easy for others to see. Make sure your doctor has injected fillers for several years and does so weekly. Actually, the only fillers others notice are overdone or misplaced. Board-certified dermatologists, facial plastic surgeons or cosmetic surgeons with years of experience can do the job.

          (Learn about injection rhinoplasty, a non-surgical nose job. Plus, see some injection rhinoplasty before and after pictures.)

  • Look younger forever with a permanent filler! Not quite. Use all the known permanent facial fillers, but your face will still continue to age. As we get older, facial bone under goes a very gradual decline while soft tissues lose volume. A permanent filler would cause an unnatural look and maybe even be in the wrong position ten years after the procedure.


Plastic Surgeons & Problem Sweating

"A woman turns to Botox after sweating too much"
Problem Sweat

Cosmetic plastic surgeons everywhere are accustomed to helping people with their self-image by making them look more refreshed, younger and wholesome.

But many – including some dermatologists who also perform cosmetic surgery — also treat patients with a strange condition known as hyperhidrosis. That condition allows the body’s cooling mechanism – perspiration – to run rampant, allowing sweat to flow like water from any of the:

  • Palms
  • Feet
  • Armpits
  • Upper body

Imagine being a salesman – famous for incessant glad handing – and having dripping wet palms.  Always. Or a female executive whose blouses are wet from the neckline to the waist.

       (Look at some before & after face and neck lift pictures.)

Hyperhidrosis has been in the news recently because patients with several types of the disorder were tested at two clinics – one apiece in Shanghai, China and Vancouver, British Columbia – for anxiety and depression. Turns out hyperhidrosis patients have much higher anxiety and depression levels and that may lead to a new treatment plan.

Currently, cosmetic plastic surgeons can use Botox for a treatment that is only one of three that medical insurance will cover. (The other two are migraine headaches and eyelid or facial spasms.) For patients who sweat profusely from the armpits, Botox is injected at several underarm locations just under the skin after numbing the area.

          (Read more about Botox and Dysport.)

According to the International Hyperhidrosis Society, Botox does its work by blocking the secretion of the bodily chemical that turns on the body’s sweat glands.

Testing has also shown excessive sweating of the hands, face and under womens’ breasts can be stifled via Botox resulting in an 82 to 87 percent decrease in sweating. Dryness usually lasts from four to 12 months and as long as 14 months.

        (See some permanent, non-surgical rhinoplasty pictures.)

Of course most physicians will try the simplest remedy first, in these cases, anti-perspiration products containing aluminum chloride.

At, the website for board-certified plastic surgeons, 93 percent of problem sweat patients said their Botox treatment was worth it.  Average cost: $1275.

          (Look at some revision nose job before & after pictures.)

MiraDry is yet another treatment, one that destroys sweat glands in the armpits via microwave energy. An experienced physician figures the microwave dosage needed and then the sweat glands are gone for good.

Only about two percent of our sweat glands are in the underarm so the body can still cool itself.

Global Plastic Surgery Statistics

"A woman's hand figures the numbers of cosmetic surgery operations"
Figuring the Numbers

Last year, it was Brazil, but now it’s the United States for which nation on earth has done the most cosmetic plastic surgeries during 2015.

So says the International Society of Aesthetic Plastic Surgery (ISAPS) which represents about 35,000 board-certified plastic surgeons worldwide and is just now releasing global plastic surgery statistics for 2015.

According to the ISAPS, the United States saw 1.2 million plastic surgeries and 2.6 million non-surgical procedures. Brazil came in second with 1.1 million non-surgical procedures and 1.2 million cosmetic plastic surgery procedures.

Next was Asian plastic surgery hot spot, South Korea followed by:

  • India
  • Mexico
  • Germany
  • Columbia
  • France
  • Italy

The annual survey showed Americans have 6,500 board certified plastic surgeons to draw on, compared to Brazil’s 5,500 and China’s 2800.

           (Read more about 2015 statistics for U.S- only plastic surgery)

The most popular procedure worldwide for men and women: Botox injections, followed by the various facial fillers containing Hyaluronic Acid, a natural substance that helps skin stay plump and hydrated.

Among woman – who had 18 million procedures or 85.5 percent of the total — breast augmentation was the most popular procedure and grew 10.4 percent over the previous year’s figures. The other top female procedures were:

  • Liposuction
  • Eyelid Surgery
  • Tummy Tuck
  • Rhinoplasty

For the guys, eyelid surgery and rhinoplasty lead the 2015 list of most commonly performed procedures.

          (See some rhinoplasty before and after pictures.)

Men also had eyelid surgery, liposuction, gynecomastia surgery, fat grafting and ear surgery, accounting for three million procedures or 14.4 percent of the total.

           (Look at some eyelid surgery before & after pictures.)

Because non-surgical procedures are growing like wildfire, more and more patients who wish to avoid nose job surgery (while saving 80 percent over the cost of surgery!) are taking advantage of a permanent, non-surgical nose job.

          (Look at some permanent, non-surgical nose job before & after pictures.)

If you think a non-surgical nose job may be right for you, you can get an exact preview how a corrected nose would look afterwards. First is numbing the nose, then injecting plain salt water, done in the office on your lunch break if you like.

The sterilized salt water dissolves in a couple of hours, but exactly duplicates how a permanent, non-surgical nose job will look when finished.

It’s known as the Kotler Salt Water Demo. Think of it as a test drive for your new, improved nose.

Awake Patients & Cosmetic Plastic Surgery

38041781 - doctors in scrubs and surgical masks scanning patient lying on hospital operating table
…….So my two kitties play together and unspool yarn and any rolls of toilette paper left out while my two grown kitties just worry about getting fed and you should see them play with the three kitties next door, but this dog…..

According to the American Journal of Surgery, a professional magazine for surgeons, more awake patients are being seen; those patients are having surgeries with only a local anesthetic to block sensations in the area being operated on.

Some surgeons like awake patients in surgery because the surgeon can ask the patient to move this way or that or answer questions during the operation.

But consider: if you are a surgeon with an awake patient who can hear all the sounds – and perhaps see some sights — around him in a typical operating room, it’s not too bad an idea to dismiss the phrase “oops!” from your vocabulary.

You might also want to find another way to ask surgical trainees to step over and take a gander at how your surgical work is going.

Studies have shown that awake patients want trainees and newbie surgeons nowhere near them.

Moreover, studies reveal that awake patients under the knife in operations – like biopsies, abortions, cataract surgery as well as some cosmetic plastic surgery procedures – tend to have shorter recovery times.

Awake patients for cosmetic surgeries often include:

Cosmetic plastic surgeons using local anesthesia usually also provide intravenous sedation medications to awake patients.

            (See some Chemical Wrinkle Remover before & after photos)

However, buyer beware: “awake” cosmetic surgery can also be an attempt at cutting corners by doing without an anesthesiologist. To cope, check thoroughly on your surgeon’s qualifications and surgical training.

For instance, Miami plastic surgeon Constantino Mendieta, M.D. avoids awake patients for buttocks and breast augmentation because he does not want the patient to move at a critical moment.

                   (Learn more about face & neck lift)

Alexander Langerman, M.D., Assistant professor of otolaryngology at Vanderbuilt University Medical Center in Nashville, Tennessee and team interviewed 23 surgeons in various specialties about operating on awake patients.

On the plus side, Dr. Langerman said most of the surgeons reported awake surgery was more efficient and satisfying overall. But downsides included talking about patients’ pain during surgery and the chance a patient would make a risky movement.  Patients generally are so put off by trainee surgeons, the group of surgeons said it was harder to teach surgical newcomers.

          (See some neck sculpture before & after pictures.)

So most surgeons in the study were less likely to allow beginning surgeons to take part in procedures. Surgeons reported trying to make things more comfortable for patients on the operating table by playing music and limiting others from entering and leaving the room.

Some surgeons offered alert patients sedatives to help them relax or fall asleep.

          (Look at some permanent, non-surgical nose before & after photos.)

Botched Nose Jobs —What to Do

" A waiter in a classy joint copes with a Botched nose job"
Coping with a Botched Nose Job

Nose Jobs are the second most often performed cosmetic surgery in the United States, according to the American Society of Plastic Surgeons (ASPS.) For instance, of the 1.7 million cosmetic surgery procedures performed in 2015, 217,979 were nose jobs, says the ASPS.

And why not? The nose is the largest and most visible feature on the face. If a nose is twisted, has a hump, turned up nostrils or is otherwise strangely shaped, it usually affects the person’s self-image and confidence because that nose just does not fit that face.

          (Look at some first nose job before & after pictures.)

Virtually all plastic surgeons say nose shaping has the highest degree of difficulty because a nose is a complex, three-dimensional structure and usually responds to the principle of “less is more.” That is, remove too much tissue and you’re likely to create an even stranger nose.

Solution? Find a cosmetic plastic surgeon with the most experience who does nose jobs at least weekly and has done so for a decade. Make sure he or she is board-certified in a facial specialty.

But, alas, according to one professional organization of facial plastic surgeons, anywhere from 15 to 25 percent of first nose jobs are botched.

Which brings us to revision rhinoplasty and its particular problems. In some cases, breathing is retarded, the nasal tip droops or, conversely, turned up so you look into the person’s nostrils instead of his or her eyes.

         (Read more about revision rhinoplasty)

 Now, you really need a super-specialist, a cosmetic facial surgeon who has performed mostly nose surgery for many decades. It’s because the challenges in revision rhinoplasty are substantial. In some cases, that nose has had six or seven prior operations. Due to past inadequate surgical skill, the patient presents a nose that has been the victim of:

  • Poor planning before surgery
  • Carelessly placed incisions
  • Too much cartilage and, sometimes, bone removed
  • Damage to delicate, convoluted nasal tip cartilage
  • Too much cartilage removed from the septum, the wall between the nostrils
  • Poor use of skin grafts

Some cases require a new nasal framework under the nasal skin.

Not to brag, but if you select a nasal surgeon with a cosmetic surgery resume like this, your chances of a successful revision are much, much higher. The recovery and healing, however, takes no longer – about 100 days – than a well done first rhinoplasty.

          (Look at some before & after revision rhinoplasty photos.)

And – be realistic. Angela Jolie’s nose only looks good on her. Your revision rhinoplasty should add aesthetic harmony to your face and profile.

Another option: ask if your botched nose job can be fixed via permanent, non-surgical rhinoplasty.

          (See some more non-surgical rhinoplasty before and after pictures.)

Non-Surgical Nose Jobs? Happy Patients!

'A happy Asian woman is thrilled after a non-surgical nose job."
Happy after a Non-Surgical Nose Job

According to the Aesthetic Surgery Journal, a professional magazine for dermatologists who do cosmetic plastic surgery, rhinoplasty is the most frequently performed cosmetic procedure in all Asia, outranked only by double eyelid surgery.

Asian rhinoplasty is so frequently requested in the Far East because Asians often have short nasal bones plus a depressed dorsum bridge.

Comparing Asian rhinoplasty to the Western version, the difference is usually augmentation for Asian noses and reduction in the West.

Asian rhinoplasty is also marked by:

  • Short noses
  • Wide nasal tips that usually point up. (Medically, “over-rotated.”)
  • Thicker skin
  • Weaker cartilage
  • Not much septal cartilage for grafting
  • Inadequate columella (the area between the nostrils.)

Virtually all Asian patients are proud of their heritage and the traditional features marking that background. Like Western patients, most merely want the nose – the largest facial feature – to fit in with and flatter their other features.

          (Learn more about ethnic rhinoplasty)

Because surgical rhinoplasty is so often done, researchers in Seoul, South Korea, studied the medical records of 242 local patients who had non-surgical nose jobs.

          (Look at some non-surgical nose job before & after photos.)

Writing in the October, 2016 issue of Dermatological Surgery, a professional magazine for dermatologists who do cosmetic facial surgery, Sung Hwan Youn, MD, in the Department of Dermatology and pathology, Hallym University Scared Heart Hospital, Hallym University College of Medicine in Anyang, Korea, and colleagues studied the surgical records of 242 patients who had a non-surgical nose job, using a hyaluronic acid filler.

One hundred twelve had nasal dorsum augmentation, eight had tip rotation and 122 had nose augmenation.

After studying all aspects of the non-surgical nose jobs, including before and after pictures, the surgeons-authors wrote:

Filler rhinoplasty offers a compelling alternative to surgical augmentation rhinoplasty in terms of:

  • Absence of social downtime (recovery.)
  • Surgical complications like contracture or thinning of the nasal tip
  • Showing the expected results of surgery to patients afraid of surgery

It turned out all 242 non-surgical nose job patients were delighted with the look of their augmented noses.

         (Read the non-surgical nose job article.)

While we hate to rain on anybody’s parade, hyaluronic acid fillers dissolve within months.

Our suggestion? Offer a permanent, non-surgical nose job by using Silikon 1000 in the micro-injection technique.

That filler and technique have a 50-year record of safety and effectiveness.

           (Learn more about Silikon 1000’s half century safety record in non-surgical nose jobs.)


Nose Job Cartilage for Aching Knees

"A doctor carefully measures the angles of a pretty woman's face"
Starting Nose Cartilage Donation

Whenever you’re having a nose job, your surgeon may have to snatch a small bit of nasal cartilage to make repairs elsewhere.

Sometimes, the septal cartilage blocks or bends (medically, deviates) into a breathing channel so the doctor moves that cartilage back to the center position.

If more cartilage donations are needed, some may be taken from the ear or from the costal cartilage between your ribs. (Sure, that’s another surgical site that needs post-surgical care.)

One thought in mid-stream before we get to the main point of this post about a new use for nose cartiladge: If the only changes are needed on the outside of the nose, you would  save:

  • Money– (80 percent less than a surgical nose job)
  • Time away from work for recovery
  • More time via short (10-minute) office appoints
  • Additional surgery
  • Three to five day recovery time

by opting for a non-surgical nose job.

(Read more about the benefits of a non-surgical nose job over rhinoplasty surgery and see some non-surgical nose job before and after pictures.)

So, nasal cartilage has one more use in research: as relief for aching knees. England’s Daily Mail reports that a pioneering new procedure takes  cartilage from a patient’s nose to grow and soothe knee  joint cartilage pain. The nose-to-knee cartilage implant isn’t being done in England yet, but 100 European patients at various centers have had the procedure which is said to be especially useful for osteoarthritis or those who are at risk for developing the disorder.

Said  Marcus Mumme, M.D. a surgeon doing the procedure: “Nasal cartilage is more resistant to inflammation; plus, nasal cartilage adapts itself to the knee joint environment.”

Donated nasal cartilage is grown in the lab for two weeks and then combined with collagen, a natural, bodily substance. The resulting patch is then  sewn into place over bad knee cartilage. Nose cartilage then meshes with knee cartilage, repairing existing damage.

The procedure may do away with metal knee transplants and could be useful in facial reconstruction after auto accidents said Ivan Martin, a tissue engineer at University Hospital Basel in Switzerland.

So far, nobody has complained about such a cartilage-enhance knee objecting to the odor of spoiled fish or burned toast.

Non-surgical Rhinoplasty: Join in!

'A soccer star shows his nose after a nose job"
Non-surgical rhinoplasty, before (left) and after

Non-surgical rhinoplasty patients often report that having permanent, injection rhinoplasty was so interesting because:

  • They were not put under anesthesia
  • They could take part in the procedure
  • They saved a lot of money versus having surgery

Patients write the checks for almost all cosmetic plastic surgery procedures. So they pay attention when they learn a permanent, non-surgical nose job usually costs 80 percent less than surgery.

  • It’s a noon time procedure.

Non-surgical rhinoplasty requires perhaps 10 to 15 minutes of your time in the surgeon’s office for three to five visits. When you leave, no tell-tale signs like bruises or swelling mar your face. You go right back to what you were doing before.

  • What You See: It’s What You Get

Before the permanent injections, the surgeon gives you a preview of a finished, non-surgical rhinoplasty; it’s known as a Salt Water Demonstration. While you watch – and direct – in a hand mirror, the doctor uses salt water to fill in the area(s) in your nose – like divots, gouges, twists or he can even hide a nasal hump. Salt water dissolves in a couple of hours, but that’s long enough to take before pictures.

  • Dread a syringe jab?

Fear not, the procedure is painless because a numbing cream is applied to your nose first.

(Watch a video showing a patient having permanent, injection rhinoplasty.)

  • Had a first, surgical nose job that failed? No problem.

As long as the needed corrections are on the outside of your nose, your nose can be treated via permanent, non-surgical rhinoplasty. (In surgical rhinoplasty, transplanted cartilage or bone can grow, twist or otherwise change.) Many patients needing a revision rhinoplasty have a permanent, non-surgical nose job instead.

  • Had functional nose surgery?

Say you’ve had surgery inside your nose to create clear breathing. But there are still some hollows, gouges, marks or even a twist in the middle of your nose. Perhaps your nostrils are unbalanced or your nasal tip needs help. Some prospective patients have had a broken nose heal in the broken position leaving a crooked nose while yet others need a heightened bridge.

Why take a chance on more surgery after that expensive functional surgery?

  • Easy Does it!

So the outcome produces a natural looking nose which the surgeon creates a little at a time. Non-surgical rhinoplasty is best done a little by little which usually means an injection followed by a wait of four or five weeks. Then, and only then, do doctor and patient decide if more is need.

          (Look at some non-surgical nose job before and after pictures.) 















Non-Surgical Nose Jobs: Patients’ Review Letters

"A lovely woman is shown in profile after a non-surgical nose job that removed a hump from her nose."
Non-surgical nose job, before (left) and after.

Provided the only changes needed are on the outside of the nose, patients can skip a surgical nose job and have a permanent, non-surgical nose job, even as a nose job revision.

(Read more about permanent, non-surgical nose jobs)

Not only does the no-knife rejuvenated nose look natural, but it usually costs 80 percent less than surgery.

A permanent, non-surgical nose job requires three to five short office appointments, separated by a wait of five to six weeks.

Sound too good to be true? Then, take a look at some of the nose surgery patient review letters sent to Dr. Kotler after their syringe-based surgery.

Patient Michelle G. wrote to say “…not too much filler is applied at once. That allows you to see where the results are headed. There is very little discomfort and no down time at all…..he (Dr. Kotler) has an amazing gift that no one else is performing.”

          (Watch a video of patient Jessica telling about her non-surgical rhinoplasty.)

 Patient T.K. had two previous nose surgeries that left the nose over-corrected and with a “conspicuous” dent that left her “a bit shy and self-conspicuous.” She writes further: “I was apprehensive about a third procedure and the possibility of complications. But three visits to your office for silicone injections and the appearance of my nose was corrected.”

T.K. loved the fact that the results of the permanent, non-surgical nose job were immediately noticeable. She concludes: “I kicked myself for not having done something sooner!”

          (Look at some permanent, non-surgical nose job before & after pictures.)

 A patient who signed himself “Better Now” suffered disfigured nostrils from a cancer operation a decade ago. Surgery left one nostril much higher than the other, leaving the patient with the feeling he was walking around with a giant fish hook pulling that one nostril up.

Wrote the patient: “Dr. Kotler, WITHOUT SURGERY, in two minutes fixed 75 percent of the problem I had lived with for 10 years.”

Dr. Kotler told the patient to come back in 45 days. “With another few injections, the problem was now 85% resolved. After my 3rd and final visit, the effects on the skin cancer marks and scars were undectable! It has now been a year since the final treatment…. It is as though I never had the cancer surgery.

“I can not say enough great things about Dr. Kotler’s competence and skill…”


Rhinoplasty Surgeon Beverly Hills